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[X]
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ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
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For the fiscal year ended
December 31, 2012
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[ ]
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TRANSITION REPORT UNDER SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
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Colorado
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34-1720075
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(State or other jurisdiction of incorporation or organization)
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(I.R.S. Employer Identification No.)
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4120 Boardman Canfield Road, Canfield, Ohio
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44406
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(Address of principal executive offices)
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(Zip Code)
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Large accelerated filer
o
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Accelerated filer
o
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Non-accelerated filer
o
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Smaller reporting company [X]
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Page
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Item 1.
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Business
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3
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Item 1A.
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Risk Factors
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21
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Item 1B.
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Unresolved Staff Comments
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21
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Item 2.
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Properties
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21
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Item 3.
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Legal Proceedings
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21
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Item 4.
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Mine Safety Disclosures
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21
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Item 5.
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Market for Registrant's Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities
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22
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Item 6.
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Selected Financial Data
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22
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Item 7.
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Management's Discussion and Analysis of Financial Condition and Results of Operations
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22
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Item 7A.
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Quantitative and Qualitative Disclosures about Market Risk
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26
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Item 8.
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Financial Statements and Supplementary Data
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26
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Item 9.
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Changes in and Disagreements With Accountants on Accounting and Financial Disclosure
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28
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Item 9A.
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Controls and Procedures
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28
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Item 9B.
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Other Information
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28
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Item 10.
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Directors, Executive Officers and Corporate Governance
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29
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Item 11.
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Executive Compensation
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30
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Item 12.
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Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters
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31
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Item 13.
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Certain Relationships and Related Transactions and Director Independence
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31
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Item 14.
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Principal Accounting Fees and Services
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32
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Item 15.
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Exhibits, Financial Statement Schedules
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34
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Signatures
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35
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1.
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providing in-home delivery, set-up and maintenance of equipment;
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2.
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providing patients and caregivers with written instructions about home safety, self-care and the proper use of equipment;
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3.
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processing claims to third-party payors and billing/collecting patient co-pays and deductibles.
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1.
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electric wheelchairs, scooters and lift chairs
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2.
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manual wheelchairs and ambulatory equipment, such as wheeled walkers, canes, and crutches;
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3.
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hospital beds;
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4.
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bathroom equipment, such as bedside commodes, shower chairs, grab bars and toilet risers;
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5.
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support surfaces, such as pressure pads and mattresses, for patients as risk for developing pressure sores or decubitus ulcers;
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6.
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threshold ramps, folding ramps and lift systems for cars or vans that make it easy to exit the home or transport electric wheelchairs or scooters.
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1.
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reputation with referral sources, including local physicians and hospital-based professionals;
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2.
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price of products and services;
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3.
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accessibility and overall ease of doing business;
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4.
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quality of patient care and associated services;
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5.
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range of home healthcare products and services;
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6.
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ability to provide local maintenance service on products sold.
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●
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Medical Necessity & Other Documentation Requirements
. In order to ensure that Medicare beneficiaries only receive medically necessary and appropriate items and services, the Medicare program has adopted a number of documentation requirements. For example, the DME MAC Supplier Manuals provide that clinical information from the “patient’s medical record” is required to justify the initial and ongoing medical necessity for the provision of DME. Some DME MACs, CMS staff and government subcontractors have taken the position, among other things, that the “patient’s medical record” refers not to documentation maintained by the DME supplier but instead to documentation maintained by the patient’s physician, healthcare facility or other clinician, and that clinical information created by the DME supplier’s personnel and confirmed by the patient’s physician is not sufficient to establish medical necessity. It may be difficult, and sometimes impossible, for us to obtain documentation from other healthcare providers. Moreover, auditors’ interpretations of these policies are inconsistent and subject to individual interpretation. This is then translated to individual supplier significant error rates and aggregated into a DMEPOS industry error rate, which is significantly higher than other Medicare provider/supplier types. High error rates lead to further audit activity and regulatory burdens. In fact, DME MACs have continued to conduct extensive pre-payment reviews across the DME industry and have determined a wide range of error rates. For example, error rates for CPAP claims have ranged from 50% to 80%. DME MACs have repeatedly cited medical necessity documentation insufficiencies as the primary reason for claim denials. If these or other burdensome positions are generally adopted by auditors, DME MACs, other contractors or CMS in administering the Medicare program, we would have the right to challenge these positions as being contrary to law. If these interpretations of the documentation requirements are ultimately upheld, however, it could result in our making significant refunds and other payments to Medicare and our future revenues from Medicare may be significantly reduced. We have adjusted certain operational policies to address the current expectations of Medicare and its contractors. We cannot predict the adverse impact, if any, these interpretations of the Medicare documentation requirements or our revised policies might have on our operations, cash flow and capital resources, but such impact could be material.
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●
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Inherent Reasonableness
. The Balanced Budget Act of 1997 granted authority to HHS to increase or reduce Medicare Part B reimbursement for home medical equipment by up to 15% each year under an “inherent reasonableness” authority. Pursuant to that authority, CMS published a final rule that established a process by which such adjustments may be made. The rule applies to all Medicare Part B services except those paid under a physician fee schedule, a prospective payment system, or a competitive bidding program. Neither HHS nor CMS has issued any subsequent communication or information for several years and therefore, we cannot predict whether or when HHS would exercise its authority in this area or predict any negative impact of any such change.
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Page
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REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM
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F-1
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FINANCIAL STATEMENTS
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Balance Sheets
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F-2
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Statements of Operations
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F-3
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Statements of Stockholders' Equity
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F-4
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Statements of Cash Flows
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F-5
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Notes to Financial Statements
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F-6 - F-9
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| Aurora, Colorado | /s/ Ronald R. Chadwick, P.C. |
| April 15, 2013 | Ronald R. Chadwick, P.C. |
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CANFIELD MEDICAL SUPPLY, INC.
BALANCE SHEETS
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Dec. 31,
2011
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Dec. 31,
2012
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ASSETS
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Current Assets
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Cash
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$ | 6,431 | $ | 7,352 | ||||
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Accounts receivable
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16,684 | 14,459 | ||||||
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Total Current Assets
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23,115 | 21,811 | ||||||
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Total Assets
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$ | 23,115 | $ | 21,811 | ||||
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LIABILITIES AND STOCKHOLDERS' EQUITY
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Current Liabilities
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Accounts payable
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$ | 26,775 | $ | 20,633 | ||||
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Related party payables
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- | 6,000 | ||||||
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Notes payable
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88,750 | 85,500 | ||||||
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Accrued interest payable
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277 | - | ||||||
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Total Current Liabilities
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115,802 | 112,133 | ||||||
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Total Liabilities
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$ | 115,802 | $ | 112,133 | ||||
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Stockholders' Equity
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Preferred stock, no par value; 5,000,000 shares authorized;
no shares issued and outstanding
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- | - | ||||||
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Common stock, no par value; 100,000,000 shares authorized;
8,000,000 (2011) and 9,500,000 (2012) shares issued and
outstanding
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500 | 15,500 | ||||||
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Additional paid in capital
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- | - | ||||||
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Retained earnings (deficit)
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(93,187 | ) | (105,822 | ) | ||||
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Total Stockholders' Equity
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(92,687 | ) | (90,322 | ) | ||||
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Total Liabilities and Stockholders' Equity
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$ | 23,115 | $ | 21,811 | ||||
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CANFIELD MEDICAL SUPPLY, INC.
STATEMENTS OF OPERATIONS
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||||||||
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Year Ended
Dec. 31, 2011
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Year Ended
Dec. 31, 2012
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Sales (net of returns)
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$ | 283,828 | $ | 308,731 | ||||
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Cost of goods sold
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145,838 | 131,011 | ||||||
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Gross profit
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137,990 | 177,720 | ||||||
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Operating expenses:
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General and administrative
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187,683 | 187,035 | ||||||
| 187,683 | 187,035 | |||||||
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Income (loss) from operations
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(49,693 | ) | (9,315 | ) | ||||
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Other income (expense):
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Interest income
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23 | 2 | ||||||
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Interest expense
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(3,426 | ) | (3,322 | ) | ||||
| (3,403 | ) | (3,320 | ) | |||||
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Income (loss) before provision for income taxes
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(53,096 | ) | (12,635 | ) | ||||
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Provision for income tax
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- | - | ||||||
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Net income (loss)
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$ | (53,096 | ) | $ | (12,635 | ) | ||
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Net income (loss) per share (basic and fully diluted)
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$ | (0.01 | ) | $ | (0.00 | ) | ||
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Weighted average number of common shares outstanding
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8,000,000 | 9,500,000 | ||||||
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CANFIELD MEDICAL SUPPLY, INC.
STATEMENTS OF STOCKHOLDERS' EQUITY
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Common Stock
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||||||||||||||||||||
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Shares
(1)
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Amount
No Par
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Paid in
Capital
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Retained
Earnings
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Stock-
holders'
Equity
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Balances at December 31, 2010
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8,000,000 | $ | 500 | $ | - | $ | (40,091 | ) | $ | (39,591 | ) | |||||||||
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Net income (loss) for the year
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- | - | - | (53,096 | ) | (53,096 | ) | |||||||||||||
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Balances at December 31, 2011
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8,000,000 | $ | 500 | $ | - | $ | (93,187 | ) | $ | (92,687 | ) | |||||||||
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Sale of common stock
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1,500,000 | 15,000 | - | - | 15,000 | |||||||||||||||
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Net income (loss) for the year
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- | - | - | (12,635 | ) | (12,635 | ) | |||||||||||||
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Balances at December 31, 2012
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9,500,000 | $ | 15,500 | $ | - | $ | (105,822 | ) | $ | (90,322 | ) | |||||||||
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CANFIELD MEDICAL SUPPLY, INC.
STATEMENTS OF CASH FLOWS
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Year Ended
Dec. 31, 2011
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Year Ended
Dec. 31, 2012
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Cash Flows From Operating Activities:
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Net income (loss)
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$ | (53,096 | ) | $ | (12,635 | ) | ||
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Adjustments to reconcile net loss to net cash provided by
(used for) operating activities:
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Accounts receivable
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6,309 | (955 | ) | |||||
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Accounts payable
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815 | (6,142 | ) | |||||
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Bad debt expense
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- | 3,180 | ||||||
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Accrued interest payable
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277 | (277 | ) | |||||
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Net cash provided by (used for) operating activities
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(45,695 | ) | (16,829 | ) | ||||
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Cash Flows From Investing Activities:
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- | - | ||||||
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Net cash provided by (used for) investing activities
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- | - | ||||||
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Cash Flows From Financing Activities:
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Notes payable - payments
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(2,750 | ) | (3,250 | ) | ||||
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Related party payables
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- | 6,000 | ||||||
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Sales of common stock
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- | 15,000 | ||||||
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Net cash provided by (used for) financing activities
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(2,750 | ) | 17,750 | |||||
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Net Increase (Decrease) in Cash
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(48,445 | ) | 921 | |||||
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Cash At The Beginning Of The Period
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54,876 | 6,431 | ||||||
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Cash At The End Of The Period
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$ | 6,431 | $ | 7,352 | ||||
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Schedule Of Non-Cash Investing And Financing Activities
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None
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Supplemental Disclosure
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Cash paid for interest
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$ | 3,149 | $ | 3,599 | ||||
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Cash paid for income taxes
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$ | - | $ | - | ||||
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Name and Address
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Age
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Position(s)
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Michael J. West
4120 Boardman-Canfield Road
Canfield, OH 44406
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58
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President, Chief Executive Officer and Director
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Stephen H. West
16325 E. Dorado Ave.
Centennial, CO 80045
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56
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Chief Financial Officer, Secretary and
Director
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Name and
Principal
Position
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Year
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Salary ($)
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Bonus ($)
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Stock
Awards ($)
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Option
Awards ($)
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Non-Equity
Incentive Plan Compensation ($)
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Nonqualified
Deferred Compensation Earnings ($)
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All
Other
Compensation ($)
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Total ($)
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Michael West
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2012
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$33,000
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-
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-
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-
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-
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-
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-
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$33,000
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2011
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$57,500
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-
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-
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-
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-
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-
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-
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$57,500
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Steve West
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2012
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-0-
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-
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-
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-
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-
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-
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-
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$ -0-
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2011
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-0-
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-
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-
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-
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-
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-
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-
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$ -0-
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Name and Address of Beneficial Owner
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Beneficial
Ownership
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Approximate
Percent Owned
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Michael J. West
4120 Boardman-Canfield Road
Canfield, OH 44406
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8,300,000
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87.4%
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Stephen H. West
16325 East Dorado Avenue
Centennial, CO 80015
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300,000
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3.2%
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All Officers and Directors as a group
(2 persons)
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8,600,000
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90.5%
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CANFIELD MEDICAL SUPPLY, INC.
(Registrant)
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Date: April 15, 2013
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By:
/s/ Michael J. West
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Name: Michael J. West
Title: President and CEO (Principal Executive
Officer)
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Date: April 15, 2013
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By:
/s/ Stephen H. West
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Name: Stephen H. West
Title: Chief Financial Officer, (Principal
Financial and Principal Accounting
Officer)
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Name
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Title
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Date
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/s/ Michael J. West
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President, CEO (Principal Executive
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April 15, 2013
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Michael J. West
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Officer) and Director
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/s/ Stephen H. West
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Chief Financial Officer (Principal
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April 15, 2013
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Stephen H. West
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Financial and Principal Accounting
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Officer) and Director
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Exhibit
Number
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Description
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Articles of Incorporation and Bylaws
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3.1
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Articles of Incorporation (incorporated herein by reference to Exhibit 3.1 filed with Form S-1 filed with the SEC on July 12, 2012)
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3.2
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Bylaws (incorporated by reference herein to Exhibit 3.2 filed with Form S-1 filed with the SEC on July 12, 2012)
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31.1
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Certification by CEO (filed herewith electronically)
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31.2
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Certification by CFO (filed herewith electronically)
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32.1
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Certification of CEO pursuant to 18. U.S.C. Section 1350 as adopted, pursuant to Section 906 of Sarbanes-Oxley Act of 2002 (filed herewith electronically)
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32.2
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Certification of CFO pursuant to 18. U.S.C. Section 1350 as adopted, pursuant to Section 906 of Sarbanes-Oxley Act of 2002 (filed herewith electronically)
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| 101 | XBRL Exhibits |
No information found
* THE VALUE IS THE MARKET VALUE AS OF THE LAST DAY OF THE QUARTER FOR WHICH THE 13F WAS FILED.
| FUND | NUMBER OF SHARES | VALUE ($) | PUT OR CALL |
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| DIRECTORS | AGE | BIO | OTHER DIRECTOR MEMBERSHIPS |
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No information found
No Customers Found
No Suppliers Found
Price
Yield
| Owner | Position | Direct Shares | Indirect Shares |
|---|